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IWASME PICK UP REQUEST <br /> RETAIL. DISTRIBUTION AND PIPE LINE <br /> ITo: Sharon Blanton P.O. Box 4848 <br /> Waste Disposal Coordinator Anaheim, CA 92803 <br /> Shell Oil Company Phone: 714-520-331.2 <br /> Fax: 714-520-3570 <br /> This Form must be filled out completely and all analyses <br /> attached. Mail. or FAX to the Waste Disposal Coordinator for <br /> characterization and transportation of material. <br /> Do you have a special pick up request? Yes No <br /> If yes , specify Date: 1-11 - 1-!' Time: Am <br /> Is the site open? Yes . X _ No <br /> If no, is it locked? Yes No <br /> Is this an operating service station? Yes No Y _ <br /> If no, what is currently on site? ,lam 11 1-13-)s <br /> Is the waste accessible? Yes 4 No <br /> For bulk shipments , who will supply loader? <br /> Consultant Contractor Transporter <br /> Company Name: L4�11�ry v4 I- <br /> Address: 1052 <br /> r� <br /> City: 1ev a-4- State: Zip: f-r6+'t, <br /> Contact: t C7 sh. Phone: (� s w <br /> Fax: <br /> SHE" IHE912=19H <br /> Distract/Environmental Engineer: _ Jc.;- N-fr& ✓i _ <br /> District: Phone:(00—) &4(o. Fax: G c.I3o <br /> SHELL FACILITY INFC)O&MON <br />' Facility Address: Li 31S Wi4,-Jv.► ��4a <br /> City: _ S'F��� .� State: C_! Zip: <br />' <br /> County: _ <br /> WIC Number: '2,p4- -?!-?!;2,t"2Zto_j CT/DT: <br /> s <br /> v..+�r►o9imi9. <br /> I <br />